Emergence of carbapenem resistance in pseudomonas aeruginosa isolates from a specialized care facility for prolonged mechanical ventilation patients

Abstract

Purpose: Pseudomonas aeruginosa is one of the leading gram-negative organisms associated with nosocomial infections (NI), especially in patients with mechanical ventilation. Among these P. aeruginosa, the carbapenems resistant strain is concerned. The aim of this study was to investigate the situation of carbapenem resistant P. aeruginosa in respiratory care ward (RCW). Methods & Materials: Retrospective data on all patients receiving prolonged mechanical ventilation (PMV) between January 2012 and December 2017 were collected at a regional hospital in Yunlin county, Taiwan. PMV was defined as mechanical ventilation for≥6 h per day for ≥21 consecutive days. Admission criteria for the RCW is the patient needs PMV longer than 62 days with haemodynamic stability and stable oxygen requirements. Patients in RCW were monitored for NI by the hospital infection control committee. Standard Centers for Disease Control and Prevention /National Nosocomial Infections Surveillance System definitions were used to identify NIs. Results: Since 2012 to 2017, there were total 153 PMV patients hospitalized in RCW. The mean age was 79 + 10 years old. The major comorbidities were hypertensive cardiovascular diseases (76.4%), diabetes mellitus (33.8%) and stroke (30.1%). The most common isolates in RCW during 2012 to 2017 were Pseudomonas aeruginosa, Proteus mirabilis, E. coli, Klebsiella pneumoniae and Acinetobacter baumannii. In RCW, the nosocomial infection density of P. aeruginosa was 1.7 per 1000 patient days. Rapid raise of carbapenem resistance of P. aeruginosa in RCW was noted after 2014. The proportion of carbapenem resistance in P. aeruginosa was 10.2% in 2012 then up to 40% in 2017. Conclusion: The incidence and prevalence of carbapenem resistant P. aeruginosa continue grow in RCW, which is an important emerging issue when caring these PMV patients in Taiwan.